Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Jongno-gu, Seoul, the Republic of Korea.
Seoul Veterans Hospital, Gangdong-gu, Seoul, the Republic of Korea.
Thorac Cardiovasc Surg. 2022 Apr;70(3):182-188. doi: 10.1055/s-0041-1727152. Epub 2021 May 3.
This study was conducted to evaluate the occurrence rate and risk factors of subaortic pannus (SAP) after bileaflet mechanical aortic valve (AV) replacement.
Between 1990 and 2014, 862 patients underwent primary AV replacement with bileaflet mechanical prosthesis. SAP was defined as (1) gradual increase in mean pressure gradient through mechanical AV without any evidence of motion limitation of the leaflets on echocardiography and (2) AV mean pressure gradient >40 mm Hg or AV peak velocity >4 m/s on echocardiography, and (3) any visible subaortic tissue ingrowth beneath the mechanical AV on echocardiography or computed tomography. Clinical and echocardiographic follow-up durations were 13.8 ± 8.0 and 10.7 ± 7.9 years, respectively.
Mean age was 51.1 ± 12.1 years and concomitant surgeries were performed in 503 patients (58.4%). Overall survival at 10 and 20 years was 84.2 and 67.1%, respectively. SAP occurred in 33 patients, and in only 2 patients during the first 10 years after surgery. The cumulative incidence of SAP formation at 10, 20, and 25 years were 0.3, 5.0, and 9.9%, respectively. The Fine and Gray model demonstrated that small prosthetic valve size (hazard ratio [HR] [95% confidence interval, CI] = 0.738 [0.575-0.946]), young age (HR [95% CI] = 0.944 [0.909-0.981]), and concomitant mitral valve replacement (MVR) (HR [95% CI] = 3.863 [1.358-10.988]) were significant risk factors for the SAP formation.
SAP occurred gradually over time with 10- and 20-year cumulative incidence of 0.3 and 5.0%, respectively. Young age, small prosthetic valve size, and concomitant MVR were risk factors for SAP formation. Therefore, we recommend efforts to select large prostheses for young patients requiring concomitant MVR.
本研究旨在评估生物瓣机械主动脉瓣（AV）置换后发生主动脉瓣下赘生物（SAP）的发生率和风险因素。
1990 年至 2014 年间，862 例患者接受了双叶机械 AV 置换术。SAP 的定义为：（1）机械 AV 通过平均压力梯度逐渐增加，而在超声心动图上无瓣叶活动受限的证据；（2）AV 平均压力梯度>40mmHg 或 AV 峰值速度>4m/s 在超声心动图上，以及（3）在超声心动图或计算机断层扫描下可见机械 AV 下方有任何可见的主动脉下组织生长。临床和超声心动图随访时间分别为 13.8±8.0 年和 10.7±7.9 年。
平均年龄为 51.1±12.1 岁，503 例（58.4%）患者同时行手术治疗。10 年和 20 年总生存率分别为 84.2%和 67.1%。33 例患者发生 SAP，仅 2 例发生在术后 10 年内。10、20 和 25 年 SAP 形成的累积发生率分别为 0.3%、5.0%和 9.9%。 Fine-Gray 模型显示，人工瓣膜尺寸较小（风险比[HR] [95%置信区间，CI] = 0.738 [0.575-0.946]）、年龄较小（HR [95% CI] = 0.944 [0.909-0.981]）和同期二尖瓣置换术（MVR）（HR [95% CI] = 3.863 [1.358-10.988]）是 SAP 形成的显著危险因素。
SAP 随着时间的推移逐渐发生，10 年和 20 年的累积发生率分别为 0.3%和 5.0%。年轻、人工瓣膜尺寸较小和同期 MVR 是 SAP 形成的危险因素。因此，我们建议为需要同期 MVR 的年轻患者选择较大的人工瓣膜。
